Summer Camp Contract

AFTER SCHOOL KARATE ACADEMY
STUDENT NAME

DATE OF BIRTH & GRADE for 2017-2018

Address:
City:
St:
Zip:
PARENT/GUARDIAN NAME
PHONE # (HOME/CELL)
PHONE # (WORK)
EMAIL ADDRESS (REQUIRED)
EMERGENCY CONTACT




Registration Fee (per child)
X $100=
(TOTAL DUE) non-refundable (includes 1 camp shirt)
Snack Account (per week)
X $10=
(TOTAL DUE per week)
CAMP SHIRT ORDER
Size
(Child Small- Adult Large)
Quantity
Number of Shirts
X
$10=
(TOTAL DUE)
Credit Card #
EXP:
By providing my account information I hereby agree to authorize Alpha & Omega After School Karate Academy to charge my card for summer camp tuition and service fees.
Cardholder’s Signature
Tuition fee {Six Flags Fee -$35/Season Pass(not included in Field Trip fees)}
Plan A 8-10 weeks (per child per week $190 (includes Field Trip fee)
Plan B 4-7 weeks (per child per week $205 (includes Field Trip fee)
Plan C 1-3 weeks (per child per week $220 (includes Field Trip fee)
Put initials in boxes of the weeks you wish to attend